Provider Demographics
NPI:1356482228
Name:ARKANSAS CARDIOVASCULAR SURGERY ASSOCIATES,P.A.
Entity Type:Organization
Organization Name:ARKANSAS CARDIOVASCULAR SURGERY ASSOCIATES,P.A.
Other - Org Name:ARKANSAS CARDIOVASCULAR SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-224-5666
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-224-5666
Mailing Address - Fax:501-228-2007
Practice Address - Street 1:9601 LILE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-224-5666
Practice Address - Fax:501-228-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57001Medicare ID - Type UnspecifiedCLINIC PROVIDER NUMBER